Friday, November 1, 2013

I missed this for some reason earlier in the week, but Brendan Nyhan had a point I agree with completely with regard to this week's sudden obsession with Barack Obama's old claim that everyone would be able to keep their current insurance under ACA:

Another possible explanation for the lack of scrutiny given to Obama’s promises is that the press often takes its cues about the flaws in a policy from the opposition party, which is part of a pattern of indexing coverage to the range of debate among political elites. In this case, conservative politicians and pundits often emphasized baseless charges like “death panels” or made speculative claims about how it is intended to undermine employer-provided insurance.

This coverage failure underscores the need for a vocal and reality-based opposition. Just as the divided Democratic opposition undermined the prominence of experts in weapons control during the debate over Iraq, Obama’s free pass on “you can keep it” illustrates how skeptical reporting depends on the combination of technical policy critiques and attention from opposition elites. If either component is absent, journalists are all too likely to miss the story.

It would be nice if reporters were self-starters who could scrutinize politician claims, figure out on their own which ones were iffy, and then nail them down. Of course, some reporters do that! But even in that world, part of the job of reporters would be to report on the claims of both parties, not just the administration. And therefore false claims about the ACA from Republicans (and not just death panels; there was the 10/4 claim, and the one about thousands of IRS agents, and of course the central one about a "government takeover) tended to drive out other reporting.

Moreover, sensible reporters who were aware of multiple false or phony claims from Republicans would be understandably less likely to pay attention to subsequent claims that might have actually been true.

It's not just health care reform, of course. Drones, for example: Republicans who are constantly concocting new Benghazi! stories are not only failing to push the press to work harder on the questions surrounding drone wars, but are taking up space that could be spent on it.

15 comments:

I was thinking about this during the recent politifact discussion, but the same conclusion applies here: suppose what's being observed is an evolution of partisan operations, mostly on the right, in which the media has been infected by endless dog whistles?

Classic example from this post: death panels. Obamacare has no death panels. It does have an Institutional Payments Advisory Board (IPAB), with an objective of squeezing waste out of the medical system by, for example, determining that your MRI is unnecessary and nixing it. This is not a death panel, though I suspect even the most liberal true-believer among us can squint their eyes such that the IPAB starts to look death panel-ish.

In the case of the present meme: I suspect there are two groups aggrieved by Obamacare's failed promise - the first are those transitionally in the individual market having cheap stopgap coverage that isn't *real* health insurance, and the second are those with individual policies not meeting the bureaucratic requirements of Obamacare (e.g. the 52 year old male contractor with the individual plan not meeting the requirement for maternity/women's care).

The right doesn't want to defend the cheapness of those in the transitional market, and they have to be a bit careful about the bureaucratic overreach for the others, so they blow the dog whistle of "Obama lied", and you fill in your own blank.

But how should the media report this? Should they report the blowing of the dog whistle as an activity? The composition of the dog whistle? The expected response? "Just the facts" seems like a hopelessly inadequate ask for the media in reporting on dog whistles.

CSH, IPAB doesn't determine that your MRI is unnecessary. It could decide that MRIs, in general, are worthless and shouldn't be supported (if it finds that to be the case), and then Congress would have to act on it.

I'm not sure I understand the difference between your two categories of people who'll have grievances. They look like pretty much the same category to me. I can see that people who inherently resent being told what to do, regardless of whether it's good for them, would have a grievance, and the relatively small number who lose their cheap policies, have to buy a more expensive one, and don't qualify for subsidies. But whatever you do, or don't do, there will be people with grievances, and some of them will be legitimate.

Scott, the point about congressional oversight is well-taken, that's a reasonable control. In general, a committee certainly might, without being a 'death panel' (per se), sentence grandma to death by deeming her treatment 'unnecessary' (presumably for cost savings reasons).

As for the two cases - well, the first guy is in the low-cost semi-insurance market, and the second one has contracted for insurance that meets his particular needs but runs afoul of Obamacare's bureaucratic requirements. The second guy's insurance is *real* insurance, unlike the first guy, though it doesn't cover things that the law mandates, things like women's health care that the single middle-aged man doesn't need.

CSH, correct me if I'm wrong, but I'm pretty sure that in both of your examples the policies, had they existed before the ACA became law, were grandfathered in and did not have to meet the laws minimum requirements. As long as the insurers didn't make significant changes the policies could still be offered. It is the insurance companies that have decided to no longer offer the policies in question.

CSH, prior to Obamacare, insurers regularly sentenced Grandmas to death because she needed treatment they didn't want to pay for. As long as Grandma was under 65, of course. IPAB doesn't outlaw treatments because they are too expensive. It identifies treatments that don't work, and declares they won't be paid for.

This is another aspect of the Republicans' post-policy politics. The thing about the objections to the ACA was that they could not be answered by amending the act. They were mindless demagoguery intended solely to cause confusion and distrust. They were fine to the extent that all Repubs cared about was defeating the ACA, and if unsuccessful, to be able to attack it for any reason real or imagined to undermine its popularity after enactment. But of course the ridiculous objections were not fine to the extent that honest attempts to make the law better might have helped the people the Repubs have so much sympathy for today.

In contrast, one Dem objection Medicare Part D was that the government wasn't allowed to negotiate drug prices. This was a real policy concern that if addressed could have encouraged some Dems to vote for it. And if the act had been amended to address Dem concerns, it would have been bad faith for the Dems who requested it to then refuse to vote for it. This sort of bad faith was rampant among Repubs during the negotiation of the ACA because they didn't want to make the law better, they just wanted reasons to oppose it.

Full scale demagoguery is inconsistent with developing policies of your own or honestly critiquing policies from the other side because policies have to be grounded in reality to even have a chance to work. Right now, Repubs much prefer the demagoguery to constructive engagement.

Funny, Geoff, that's a great illustration of how this sort of thing cuts both ways. I should start by acknowledging that I enjoy your comments and don't write the following to call you out but rather to point out how "negotiating drug prices" is an iconic example of exactly the same phoniness on the other side - which phoniness, coming from Dems, bothered the mainstream liberal media not at all.

The meme was ubiquitous on the left in 2003, when part D was in the works. It has remained in force off and on since: why doesn't the US government, like Canada, aggressively negotiate prices, or short of that, why don't we just import our drugs from Canada?

The answer is fairly obvious to anyone who thought about it for more than 30 seconds; it was obvious to all of the Democratic politicians hypocritically pushing that meme in '03. The Canadian government exploits its status as a secondary, add-on market to extract huge concessions from big pharma; if the much bigger US govt tried the same thing it would severely compromise Big Pharma's ability to recoup the extraordinary costs of drug development.

Again, "everyone" knows that. The posing Democratic congressmen knew that. And yet, pose they did, anyway. I guess the point is that hypocrisy is a dress that looks a lot better on the other person than it does on us.

How does pointing out that Republicans were basically lining up with big pharna's profitability at the expense of US consumers equate with phoniness? Why is it that we consumers in the US have to subsidize drug costs for Canada and the developing countries in the rest of the world?

Well nanute, paying prevailing Canadian prices for Rx, either through reimportation or negotiation, would undoubtedly be a good thing. There are two possible responses to such a US govt effort on the part of Big Pharma:

1) Accept the new bargain-basement prices in the US, thus jeopardizing their very existence, or

2) (in the reimportation case) Telling the Canadian government to pound sand, no longer accepting those rock bottom prices.

Everyone who thought about it, including all those Democratic congresscritters, knew which would occur in the case of such a policy. So do you, no? Its obvious. Which is what makes the proposal of such a policy so inherently phony: its like the "chicken in every pot" or "magic happy pills for everyone" - sounds good to hear but is transparently divorced from the constraints of real life.

Thanks for the response, CSH (I love getting called out in good faith, and you always argue in good faith). I confess that I did not follow the Part D debates that closely, but I'm still not sure that Dems knew that government negotiation of drug prices - which the VHA does successfully (albeit not on the massive scale of Part D) - was impracticable, but asked for it anyway just to make trouble.

I did a quick search of Ezra Klein's articles in TAP, and glancing at them, it appears that he, anyway, thought negotiating prices was a good idea. (He also links to pieces by Dean Baker and Krugman.) The first article I saw pushes back on the DLC plan to have market competition as the means of controlling prices, and touts negotiation instead.

I chose Ezra because, while he can be wrong in any particular case, he usually doesn't write stuff he doesn't believe in order to ratf**k the opposition. IOW, you can argue that Ezra is wrong and government negotiation would be the death of Big Pharma; indeed you may be right. But I'm going to need some more convincing that Ezra knows negotiation is a bad idea, but raised it so he could oppose Part D for reasons he knows are bogus, which is the behavior I'm attributing to Repubs.

As an aside, I wouldn't call what Repubs are doing "hypocrisy," but rather refusal to participate in governance while Dems are in charge, preferring instead to throw every damn thing they can think of against the wall to make it as difficult as possible for Dems to do anything. This may be good politics (the Anonymous Who Used to Say "Shiftless" thinks it is), but it requires disengagement from the real world, which makes coming up with real world policies, or real world objections to Dem policies that might make actually make the policies better, difficult or impossible.

Finally, on the substantive point, it's interesting that conservatives' main way to reduce health care costs is to make "consumers" bear more of the costs, relying on the resulting competition to reduce prices, yet also believe that these consumers should pay a premium for asthma inhalers and other drugs or they can't have them at all.

nanute - thanks for the question - maybe this example will clarify: suppose the Bavarian Motor Works comes up with a fancy new sports car with variable cost = $9,900 and fully loaded cost (e.g. all the development+ fixed cost included) = $50,000. BMW intends to sell this car in North America.

Canada might insist that BMW charge Canadian consumers no more than $10,000 per car. BMW won't like that! However, if the business model has the sports car's fixed cost recovered in the US market, BMW may grumble about Canadian pricing but they might still sell the car as they make $100 (variable) profit in Canada.

And a enterprising US journalist or disingenuous politician may claim "Hey, Canada pays $10 grand for a Beemer, we should too!" Its an idea, yeah, but it would also be the end of BMW in North America, as the business is not sustainable with such prices prevailing across the continent. The same thing applied in the Rx market. Your democratic congresscritters realize this. But they push reimportation anyway because they are disingenuous and say what the hoi polloi wants to hear.

Aside to Geoff - government negotiating prices? I guess it depends. Do you mean Canadian-level prices? Absurd. Do you mean extracting a few more percentage points from the drug manufacturers? Maybe, but keep in mind that, like the ACA, part D is administered by big health care, which would have squeezed Big Pharma pretty well over the years. Unless you intend to do something inherently self-destructive like force Canadian prices on the Rx manufacturer, its hard to see how the US govt negotiating (instead of Big Health Care) would make that much of a difference.

It's a very useful observation. The greatest lack of oversight occurs when the opposition actually agrees with the administration's actions. We see this with the drone wars -- only Rand Paul has questioned the use of drones outside of US borders. Nor do most Republicans care if Obama retaliates against Snowden for exposing that Clapper lied under oath.

Of course, Obama's comment about keeping your health plan is obviously false: the purpose of ACA was to make sure health plans cover essential benefits, which was necessary because many plans don't. I suspect that nobody questioned Obama about the comment because it was understood that he didn't mean it literally – I suppose he meant that those with group insurance would continue to have group plans and those with individual policies would continue to have individual plans. I'm reminded of the Reagan tax reform plan when Reagan repeatedly said it was taxpayer neutral. It wasn’t: it raised taxes paid by those with lower income (primarily by increasing the payroll tax) and lowered taxes paid by those with higher income (primarily by decreasing the top marginal rates and the capital gains rate). Yet, few objected and Reagan kept repeating the comment because it was understood that Reagan didn’t mean it literally – I suppose he meant that those with the same income would be treated the same. Why is it such a big deal today and but wasn’t in the 1980s? I wouldn’t attribute the difference to whether there’s a reality-based opposition; I’d attribute it to whether there’s a reality-based press.

I'm struck by the idea that no one reads the Federal Register. What good is transparency in government if there's no eyeballs looking through the glass? Or maybe the Federal Register is too old-fashioned for people to follow?